Known in the present state of the art are cryogenic-and-ultrasonic surgical instruments, particularly, probes which comprise a mechanism joining the working portion with the source of ultrasonic vibrations, a jacket for refrigerant to pass, interposed between the instrument base and the source of ultrasonic vibrations, and a nozzle located at the inlet of the refrigerant to the instrument (cf., e. G., USSR Inventor's Certificate No. 460,869 Int. Cl. A61F 7/00, 1975, Bulletin No. 7, inventors A. A. Pisarevsky et al.). However, the instrument is unsuitable for surgery as not capable of dissecting tissues.
There is known a cryogenic-and-ultrasonic scalpel, comprising a body accommodating a source of ultrasonic vibrations, a blade connected to the source of ultrasonic vibrations through a vibration transferring member and a tubular heat exchanger for refrigerant to admitted to and withdrawn from the blade. The best exchanger is fashioned as a U-shaped tube installed with a possibility of thermal contact with the blade lateral surface and is connected to the refrigerant admission and withdrawal pipes through bellows located within the zone of a standing wave arising when the blade is connected to the source of ultrasonic vibrations. The tubes of the heat exchanger taper towards the cutting edge of the scalpel. (cf., e.g., USSR Inventor's Certificate No. 825056 Int.Cl. A61B 17/36, 1981, Bulletin No. 16, inventors L. M. Paramonova et al.).
Disadvantages inherent in the aforesaid cryogenic-and-ultrasonic scalpel reside in a low hemostatic effect and inadequate tissue dissection rate in surgery on soft tissues and parenchymatous organs, such as the liver or pancreas, due to too low refrigerating capacity of the U-shaped tubular heat exchanger. These disadvantages stem from the fact the blade features direct and thermal contact with the transformer at the point of their interconnection. In this case, a considerable part of the heat evolved by the vibration transferring member and the source of ultrasonic vibrations due to a great loss of conversion of electric ultrasonic power into mechanical power, is translated to the blade, thus causing its temperature rise. As a result, the refrigerating capacity of the U-shaped heat exchanger which is in thermal contact not only with the blade but also with the abundantly blood-supplied organ being operated (e.g., the liver), happens to be insufficient, especially in cases of prolonged surgery, thus causing tissue sticking to the blade, reduced tissue dissection rate and adversely affected hemostatic therapeutic effect.
Moreover, the U-shape of the heat exchanger featuring the refrigerant admission and withdrawal pipes spaced somewhat apart renders the instrument too unwieldy and hence inconvenient in operation.